{"paper_id":"7e393c9d-a58a-48b3-a735-e0c80263913f","body_text":"Abstract\nObjective\nTo deeply explore the psychosocial adaptation experience of hysterectomy patients at various stages, with the aim of constructing a conceptual model to describe the complex experience of psychosocial adaptation.\nMethods\nSemi-structured in-depth interviews were conducted on twelve patients undergoing hysterectomy using hermeneutical phenomenological methods, and the data were analyzed using the Smith analysis method.\nResults\nwere refined into four stages and ten sub-themes: (1) Shock and Confusion Stage: shock and unwillingness, fear and anxiety; (2) Physical and Mental Dilemma Stage: surgical trauma, self-cognitive impact, and increasing dependence on social support; (3) Adjustment and Exploration Stage: correcting self-efficacy, self-cognitive reconstruction, and exploring social boundaries; (4) Integration and Adaptation Stage: returning to social roles and achieving closed-loop psychosocial adaptation.\nConclusion\nThe conceptual model of psychosocial adaptation offers amore systematic and comprehensive consideration and reveals a comprehensive panorama of how women undergoing hysterectomy gradually adapt and integrate into society. Medical staff are reminded to pay close attention to the psychological change requirements of hysterectomy patients at different stages, provide healthcare-emotional-knowledge-economic support, strengthen physiological-psychological-behavioral linkage management, reduce or eliminate negative emotions, and promote their early integration into society.\nIntroduction\nThe uterus is a unique reproductive organ of women. It is capable of nurturing life and serves as a symbol of womanhood. Currently, hysterectomy ranks second among obstetrics and gynecology surgeries worldwide [Citation1] and is one of the most common treatments for gynecological disorders. Studies have demonstrated that following hysterectomy, it is not only prone to causing pelvic floor dysfunctional diseases, such as pelvic organ prolapse and urinary incontinence [Citation2], but also a series of problems, including depression, fear, inferiority, decreased sexual function, and reduced social adaptability [Citation3,Citation4]. Hence, hysterectomy has a significant impact on women both physically and psychologically. With the development of social psychology, JiaMing X [Citation5] and other scholars defined the state and level at which patients autonomously adjust their emotions, cognition, and behavior in order to achieve a balance between the individual and the environment as psychosocial adaptation, which is an important predictor of disease recovery and quality of life. Reviewing the research on psychosocial adaptation in the field of hysterectomy, it is found that most studies primarily describe the level and influencing factors of psychosocial adaptation in hysterectomy patients, pay relatively less attention to the experience of psychosocial adaptation, and have not formed a systematic and complete framework to explain this complex experience. Therefore, this study aims to explore the psychosocial adaptation experience of hysterectomy patients through hermeneutical phenomenology, analyze how they adjust themselves and integrate into society step by step, thereby identifying the influencing factors of psychosocial adaptation, and constructing a systematic and comprehensive conceptual model to describe the complex experience of psychosocial adaptation, thereby providing a certain basis for researchers and medical staff in related fields to formulate intervention plans.\nParticipants and methodology\nParticipants\nA convenience sampling method was employed to recruit 12 patients who had undergone hysterectomy from a tertiary obstetrics and gynecology hospital in Hebei Province between May and August 2024. The inclusion criteria were as follows: aged 18 years or older; having undergone total hysterectomy; voluntarily agreeing to participate in this study; and having clear language ability. The exclusion criteria encompassed individuals with cognitive impairment and those with communication disabilities such as being deaf or mute. This study was approved by The Fourth Hospital of Shijiazhuang Ethics Committee (Ethics Approval Number 20240047). The sample size was determined based on data saturation, and ultimately 12 patients were included. General information about these patients is presented in .\nMethod\nDevelopment of the interview guide\nThe research team initially drafted an interview guide, which was revised and refined through reviews by gynecological expert Li Lihui (with 20 years of clinical research experience) and Dr. Jia Xuejing, a nursing scholar specializing in psychosocial research. Li ensured the surgical-related questions were accurate and comprehensive, while Jia optimized the phrasing of psychosocial questions to elicit in-depth and honest responses. Following pilot interviews with 2 hysterectomy patients, the guide was further adjusted based on feedback and expert suggestions to finalize the formal version: (1) Interview Guide for One Day Before Discharge ① When you learned that a hysterectomy was necessary, how did you feel and what were your thoughts? ② During your hospital stay, what notable physical or psychological changes or experiences have you had? ③ Based on your current condition, what specific areas of support do you need (e.g. psychological, family, work, daily life)?(2) Interview Guide for Three Months Post-Discharge ① In the three months since discharge, what significant changes have you noticed in your physical condition (e.g. energy levels, sleep, appetite) and emotional state (e.g. mood, emotional stability)? ② How have these changes impacted your daily life, including activities, social interactions, and family dynamics? ③ What specific actions have you taken to cope with these changes, such as managing physical discomfort or regulating emotions?\nData collection\nData were collected using semi-structured face-to-face or telephone interviews, conducted twice with the same participants: once on the day prior to hospital discharge and again three months post-discharge. The first interviews were all performed in a gynecological consultation room through one-on-one face-to-face sessions. For the second follow-up, 5 participants chose telephone interviews, while the remaining 7 underwent in-person one-on-one interviews in the same consultation room, with no other individuals present besides the researcher and participant. Each interview lasted 20–30 min.Prior to data collection, participants received a detailed explanation of the study objectives and provided written consent. Interviews were audio-recorded and documented in real time by the researcher. Audio files and written records were securely managed by a dedicated team member to ensure confidentiality. All interviews were conducted exclusively by the primary researcher to maintain consistency in data collection.\nData collation and analysis\nThe recording will be transcribed into text within 24 h following the interview, and then organized and refined. If there are any questions or ambiguities, they will be reconfirmed with the interviewees. The interview data were sorted and analyzed using the explanatory phenomenological analysis method proposed by Smith et al. [Citation6]. Two members of the research team organized and verified the original data, performed coding, classification, and theme refinement, and combined theory with themes to construct an interpretation framework. In the event of disagreement, consensus is reached through group discussions.\nResults\nThis study finally refined the results into 4 stages and 10 sub-themes:\nShock and Confusion Stage: shock and unwillingness, fear and anxiety;\nPhysical and Mental Dilemma Stage: surgical trauma, self-cognitive impact, and increasing dependence on social support;\nAdjustment and Exploration Stage: correcting self-efficacy, self-cognitive reconstruction, and exploring social boundaries;\nIntegration and Adaptation Stage: returning to social roles, closed-loop psychosocial adaptation.Based on Roy’s Adaptation Theory [Citation7,Citation8], we further explored the relationships and connections between different stages and sub-themes, and interpreted and analyzed them to build a systematic conceptual model, which represents a complex psychological process (see ).\nShock and chaos stages\nShock and unwillingness\nInterviews revealed that most patients were almost shocked by and found it unacceptable to the reality of needing a hysterectomy, and exhibited an unwilling attitude. N4: “My mind was blank at the time and I couldn’t accept this fact. (sobbing)” N2: “I’m divorced and want to have another child. I don’t want to have this surgery (pain).”\nFear and anxiety\nFacing surgery, most respondents displayed fear and anxiety regarding unknown situations such as the surgical procedure and postoperative recovery. N9: “I am not in good health, and I am worried that I will not recover well after the operation.” N10: “I don’t have medical insurance, and my family is very difficult. The operation costs a lot of money, and I am afraid of burdening the children.” N11: “I particularly want to know about surgical methods, anesthesia risks, and other issues.”\nPhysical and mental distress stage\nSurgical trauma\nMany interviewees stated that their bodies were directly affected following the operation. N7: “The abdominal operation I underwent was so painful that I couldn’t sleep well.” N9: “I have a catheter and a drainage tube and dare not turn over.” N4: “I always feel groggy and nauseous. It’s too uncomfortable.”\nSelf-cognitive impact\nInfluenced by the Confucian culture of our country, some interviewees believe that the loss of a uterus represents physical disability and a change in female identity. N1: “I have lost my uterus, and I feel like I am not a woman anymore (inferiority complex).” N11: “We can’t have children anymore. We might get divorced (inferiority complex).”\nIncreased dependence on social support\nAlmost all patients have expressed strong needs for social support from medical staff, spouses, family members, and friends. N11: “I hope doctors will provide professional advice and rehabilitation guidance.” N5: “During my hospitalization, my husband stayed with me, and I felt very relieved.” N11: “My friend also had this kind of operation, which gave me a lot of useful experience.”\nAdjustment and exploration stage\nAppropriate self - efficacy\nSome interviewees actively reacted to the changes in their bodies and made efforts to adjust to their post - operative conditions. For example, N4 stated, “After soaking my feet and doing some exercise, my stomach condition has improved significantly.” N8 said, “I’ll gradually increase my activity level to return to my normal daily state as soon as possible.”\nSelf - cognitive reconstruction\nInterviews indicated that several interviewees had started to come to terms with the reality and embrace the new definition of female identity. For instance, N3 commented, “Friends often interact with me, and I’ve also come to realize that women are not solely defined by their ability to bear children.” N12 expressed, “Currently, I’m more focused on my health and work, and I’m no longer fixated on the surgery.”\nExploration of social boundaries\nMany interviewees stated that they would disclose varying amounts of information regarding their hysterectomy depending on the specific situation. For example, N5 said, “I merely informed my colleagues that I had undergone gynecological surgery.” N4 shared, “I confided this to my best friend, and she was understanding.”\nIntegration and adaptation stage\nResuming social roles\nSome interviewees claimed that they had regulated their physical and mental conditions and resumed their normal lives. N3 remarked, “I am now capable of taking care of my family and working as usual, without any changes.” N12 stated, “I have already begun working and I’m feeling well.”\nPsychosocial closed loop\nSome interviewees stated that they had calmly confronted the current situation and assimilated into society. N6 remarked, “My colleague inquired about my physical condition, and I answered her frankly.” N11 said, “I still share my experiences in this area with others.”\nDiscusses\nBuilding a conceptual model of psychosocial adaptation and focusing on the real-world scenarios of hysterectomy patients\nThe conceptual model developed in this study outlines the complex experiences of women at various stages of hysterectomy, revealing a four-stage psychosocial adaptation trajectory—”shock/chaos, physical/psychological distress, adjustment/exploration, and integration/adaptation”—which presents a comprehensive picture of their psychosocial adaptation. This aligns with Casarin et al. [Citation9].which reports that the psychological states of hysterectomy patients evolve in distinct stages, consistent with the stage-specific changes observed in our model.Rooted in Roy’s Adaptation Model [Citation8], the framework emphasizes the holistic adaptive responses of individuals as integrated systems to internal and external stimuli. It elucidates the processes and outcomes of adaptation mechanisms, mapping these to the four identified psychological stages to define the trajectory of patients’ emotional and cognitive shifts. Additionally, using the triadic reciprocal determinism from social cognitive theory [Citation10], the model illustrates dynamic interactions between self-efficacy, cognition, and behavior during the “adjustment/exploration” and “integration/adaptation” phases, with Katch’s [Citation11] research on the critical role of self-efficacy in disease coping providing empirical support for this relationship.\nThe study further identifies that not all patients experience the “shock/chaos” stage, and some encounter difficulties transitioning from “distress” to “integration/adaptation,” influenced by individual differences in life experiences, education, and family background—findings consistent with Muñiz et al. [Citation12,Citation13] on how personal contexts shape psychological coping processes during illness.Overall, this framework offers a systematic and comprehensive perspective for researchers and healthcare providers to understand the social reintegration process of hysterectomy patients. In clinical practice, healthcare providers can assess patients’ psychological adaptation patterns by exploring their life backgrounds and past coping strategies. For individuals with strong self-regulation abilities, interventions should focus on enhancing self-efficacy by leveraging their inherent strengths, while for those relying more on external support, coordinating family and social resources to provide emotional and practical assistance becomes a priority. By guiding patients through the transition from “shock/chaos” to “integration/adaptation,” this approach aims to improve their quality of life and facilitate seamless social reintegration, addressing the multifaceted needs of their physical, psychological, and social well-being.\nProviding emotional-knowledge-financial support to reshape the psychological barriers of hysterectomy patients\nHysterectomy, as a powerful stressor, imposes significant physical and psychological distress on patients. In this study, patients in the “shock/chaos” stage were universally overwhelmed by fear, anxiety, and uncertainty about the surgery. As they entered the “physical/psychological distress” stage, dual pressures from physical recovery and emotional adjustment gave rise to anxiety and depression, sometimes leading to treatment avoidance. These findings align with Zhang Jiale et al. [Citation14], which reported that patients resist treatment due to concerns about surgical risks, recovery outcomes, and financial burdens—consistent with the psychological patterns of individuals under stress. This highlights the need for healthcare providers to address patients’ early emotional needs through multidimensional support encompassing emotional, informational, and economic assistance to rebuild their psychological resilience.\nInterventions by stage\nShock/Chaos Stage: Healthcare providers should proactively explain surgical procedures and post-operative recovery, use cognitive-behavioral therapy (CBT) [Citation15] to correct irrational cognitions, and encourage family members to provide emotional support. These actions help patients reduce fear, accept their condition, and confront the surgery constructively.\nPhysical/Psychological Distress Stage: Establish nurse-led educational teams (supported by attending physicians) to deliver health information through hysterectomy manuals and short videos. Launch the “Reborn Rose” support group to foster peer-to-peer mutual aid, reducing self-identity shocks caused by uterine loss and facilitating self-cognition reconstruction [Citation16].\n“Hospital-Society-Hospital” Linkage Model: For uninsured or financially vulnerable patients, assist in applying for social (social assistance), teach family members basic nursing skills to reduce professional care costs, and dynamically assess mental health through regular screenings. Integrate mindfulness-based therapies [Citation17] to help patients rediscover personal value and restore mental barriers, as emphasized in Zhang’s [Citation18] research demonstrating that stage-specific interventions significantly improve psychological outcomes.\nPractical optimizations\nShock/Chaos Stage: Beyond routine education, utilize virtual reality (VR) technology to immerse patients in simulated surgical processes, enhancing their understanding of the procedure and alleviating fear by filling cognitive gaps about the unknown.\nDistress Stage: Organize regular knowledge seminars featuring recovered patients to share real-life experiences, amplifying the effectiveness of peer support. The authenticity and empathy of these narratives strengthen the mutual-aid role of the “Reborn Rose” group.\nEconomic Support: Assign dedicated staff to coordinate social assistance applications, streamlining processes to ensure timely financial aid—an essential step to bridge the “hospital-society-hospital” continuum and enhance the efficiency of the intervention system.\nThis structured approach integrates evidence-based strategies with patient-centered care, addressing the multifaceted challenges of hysterectomy to promote psychological adaptation and treatment adherence.\nStrengthening physiology-psychological-behavioral linkage management to promote hysterectomy patients’ adaptation to society\nThis study deeply analyzes the internal and external factors influencing hysterectomy patients’ transition from “shock/chaos” to “integration/adaptation,” identifying physical recovery, psychological regulation, and behavioral coping as key drivers of psychosocial adaptation. With support from internal strengths and external resources, patients can reconstruct self-cognition, employ diverse strategies to manage surgical stress, and adapt through proactive behaviors like engaging in treatment and social activities—processes that align closely with Roy’s Adaptation Theory [Citation19]. The degree of psychosocial adaptation is closely linked to post-operative quality of life, with multiple factors shaping this journey.\nNotably, patients undergoing surgery for malignant diseases exhibit more complex psychological adaptation than those with benign conditions, characterized by longer adjustment periods and higher anxiety levels. This aligns with Kaya et al. [Citation20], who found that cancer-related stress (e.g. diagnostic shock, uncertain survival prognosis) complicates cognitive reconstruction during the “shock/chaos” stage and triggers self-identity crises (e.g. loss of female role or reproductive function) in the “distress” stage. Additionally, open-abdominal surgery patients experience severe post-operative pain and prolonged mobility limitations, impairing social engagement and quality of life—consistent with Kaya et al.’s [Citation21] findings on surgical modality differences. Physical discomfort creates a “pain-emotional suppression-social withdrawal” cycle, exacerbating behavioral avoidance during the “adjustment/exploration” phase. For patients with cancer metastasis, adaptation barriers concentrate on self-efficacy reconstruction in the “integration/adaptation” stage, manifesting as persistent fear of recurrence, hypersensitivity to treatment side effects, and excessive reliance on social support. These findings validate the differential impact of disease-related factors on patients’ psychological adaptation.\nBased on these insights, clinicians are advised to design tailored interventions\nMalignant disease patients: Provide long-term psychological counseling and anti-cancer survivor stories to bolster treatment confidence.\nPoor pathology outcomes: Increase follow-up frequency and deliver timely reassurance about disease stability to alleviate anxiety.\nOpen surgery patients: Guide early bed-based rehabilitation exercises, gradually increasing activity levels, while encouraging participation in peer support groups (e.g. recovery exchange activities) to facilitate social reintegration.\nAdditionally, integrating rational emotive behavior therapy (REBT) to address cognitive distortions and establishing a “physical-psychological-behavioral” integrated management system—offering comprehensive self-management support—can enhance quality of life and promote psychosocial adaptation. This patient-centered approach bridges biological, psychological, and social domains, ensuring holistic care that aligns with the dynamic needs of hysterectomy survivors.\nConclusions and shortcomings of this study\nThis study constructs a conceptual model using hermeneutical phenomenology to elucidate the complex experience of psychosocial adaptation among hysterectomy patients, thereby providing a theoretical foundation for researchers and medical staff in related fields to formulate intervention strategies. However, a limitation of this study is that there is not a sufficient number of participants to validate the conceptual model. In the future, efforts will be made to prove the authenticity and reliability of the complex experience model of psychosocial adaptation of hysterectomy patients.\nAcknowledgments\nI would like to express my sincere gratitude to my supervisor, Dr. Jia, for her invaluable guidance, continuous encouragement and insightful suggestions throughout this research project.My special thanks go to my fellow lab members, Lihui Li, Haibin Zhang, Shujie Liu, Qianqian Zhao, who provided me with a stimulating research environment and helped me with numerous experiments and discussions. Last but not least, I owe my deepest gratitude to my family. Their unwavering love and patience enabled me to focus on my studies. Huiyan Wang, Lihui Li: Made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data; Xuejing Jia, Haibin Zhang, Huiyan Wang: Involved in drafting the manuscript or revising it critically for important intellectual content; Huiyan Wang, Lihui Li, Shujie Liu, Xuejing Jia, Haibin Zhang, Qianqian Zhao: Given final approval of the version to be published. Each author should have participated sufficiently in the work to take public responsibility for appropriate portions of the content; Huiyan Wang: Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.\nData availability statement\nThe data that support the findings of this study are openly available in “figshare” at https://fairsharing.org/, reference number https://fairsharing.org/users/13732.\nReferences\n- Danielle I, Michelle I, Michael CG. H. Benign hysterectomy operative times and 30-day complications: a cohort study. Journal of Minimally Invasive Gynecology. 2021;29(3):429–439. doi:10.1016/J.JMIG.2021.11.00\n- Ting LY, Wu LA, Hui ZZ, et al. Perceptions of pelvic floor dysfunction and rehabilitation care amongst women in southeast China after radical hysterectomy: a qualitative study. BMC Women’s Health. 2022;22(1):108. doi:10.1186/S12905-022-01687-0\n- Ferhi M, Marwen N, Abdeljabbar A, et al. Psychological outcomes and quality of life after hysterectomy for Benign diseases: a prospective cohort study. Cureus. 2024;16(5):e60871-e. doi:10.7759/CUREUS.60871\n- Ts R, Andrew S, Sarah S, et al. Psychosocial predictors of change in sexual activity and sexual function after hysterectomy in women with pelvic pain. Am J Obst Gynecol. 2023;229(3):322.e1–e8. doi:10.1016/J.AJOG.2023.06.026\n- JiaMing X, QiQi JS, YaoXia K, et al. Y. Psychosocial adaptation profiles in young and middle-aged patients with acute myocardial infarction: a latent profile analysis. Eur J Cardiovasc Nurs. 2024;23(3):267-277. doi:10.1093/EURJCN/ZVAD071\n- Smith JA, Osborn M. Interpretative phenomenological analysis as a useful methodology for research on the lived experience of pain. Br J Pain. 2015;9(1):41–42. doi:10.1177/2049463714541642\n- Çelik N, Saruhan A. The experiences of women diagnosed with precancerous cervical lesions, and their spouses, according to the Roy Adaptation Model: model-based qualitative research. Appl Nurs Res. 2025;81:151894. doi:10.1016/J.APNR.2024.151894\n- Maleda T, Nega A, Teji RK, et al. Women’s hospital birth experiences in Harar, eastern Ethiopia: a qualitative study using Roy’s adaptation model. BMJ Open. 2022;12(7):e055250. doi:10.1136/BMJOPEN-2021-055250\n- Casarin J, Ielmini M, Cromi A, et al. Post-traumatic stress following total hysterectomy for benign disease: an observational prospective study. J Psychosom Obstet Gynaecol. 2022;43(1):11–17. doi:10.1080/0167482X.2020.1752174.10\n- Martín CA, Rivera DE, Hekler EB, et al. Development of a control-oriented model of social cognitive theory for optimized mHealth behavioral interventions. IEEE Trans Control Syst Technol. 2020;28(2):331–346. doi:10.1109/TCST.2018.2873538\n- Katch H, Mead H. The role of self-efficacy in cardiovascular disease self-management: a review of effective programs. PI. 2010;2010:33. doi:10.2147/PI.S12624\n- Adise S, West AE, Rezvan PH, et al. Socioeconomic disadvantage and youth mental health during the COVID-19 pandemic lockdown. JAMA Netw Open. 2024;7(7):e2420466. doi:10.1001/jamanetworkopen.2024.20466\n- Orres Blasco N, Costas Muñiz R, Zamore C, et al. Cultural adaptation of meaning-centered psychotherapy for latino families: a protocol. BMJ Open. 2022;12(4):e045487. doi:10.1136/bmjopen-2020-045487\n- Zhang Jiale YX. Preoperative psychological intervention for patients undergoing total hysterectomy during the perioperative period. J People’s Liberation Army Hosp Manage. 2020;27(04):397–400. doi:10.16770/J.cnki.1008-9985.2020.04.028\n- Jianhua S. The influence of rational cognitive behavioral therapy on improving the psychological state and quality of life of patients undergoing hysterectomy. Psychol Month. 2021;16(14):149–150. doi:10.19738/j.cnki.psy.2021.14.069\n- Chen Taiming NY, Peiying C, Mengju Z, et al. Study on the influence of peer support on the psychological state and quality of life of middle-aged patients with heart failure. J Nurs Manage. 2024;24(01):26–31.\n- Yang Yafang ZW. The influence of mindfulness therapy on self-compassion and stigma in first-episode schizophrenia patients. Modern Chin Doctors. 2019;57(17):91–94.\n- Zhang Dongmei YL, Lingcao M. The influence of individualized staged psychological intervention in the perioperative period on the psychosocial adaptation level and quality of life of patients with laryngeal cancer. Chin J Health Psychol. 2023;31(07):1046–1052. doi:10.13342/j.cnki.cjhp.2023.07.017\n- Ruimei L. Influence of Roy’s adaptation model nursing combined with relaxation psychotherapy on the quality of life of patients with abnormal uterine bleeding. Heilongjiang Med. 2024;37(6):1462–1464.\n- Kaya C, Alay I, Cengiz H, et al. Comparison of hysterectomy cases performed via conventional laparoscopy or vaginally assisted natural orifice transluminal endoscopic surgery: a paired sample cross-sectional study. J Obstet Gynaecol. 2021;41(3):434–438. doi:10.1080/01443615.2020.1741523\n- Kaya C, Alay İ, Ekin M, et al. Hysterectomy by vaginal-assisted natural orifice transluminal endoscopic surgery: initial experience with twelve cases. J Turk Ger Gynecol Assoc. 2018;19(1):34–38. doi:10.4274/jtgga.2017.0075","source_license":"CC0","license_restricted":false}